High Fluid Intake Research Articles

Dysnatremia among runners in a half marathon performed under warm and humid conditions

BackgroundDysnatremia has been associated with sports activity, especially long-distance running and endurance sports. High fluid intake is associated with hyponatremia. This study aims to evaluate dysnatremia and risk factors in...

Real-Time Observations of Food and Fluid Timing During a 120 km Ultramarathon.

The aim of the present case study was to use real-time observations to investigate ultramarathon runners' timing of food and fluid intake per 15 km and per hour, and total bodyweight loss due to dehydration. The study included 5 male ultramarathon runners observed during a 120 km race. The research team members followed on a bicycle and continuously observed their dietary intake using action cameras. Hourly carbohydrate intake ranged between 22.1 and 62.6 g/h, and fluid intake varied between 260 and 603 mL/h. These numbers remained relatively stable over the course of the ultra-endurance marathon. Runners consumed food and fluid on average 3–6 times per 15 km. Runners achieved a higher total carbohydrate consumption in the second half of the race (p = 0.043), but no higher fluid intake (p = 0.08). Energy gels contributed the most to the total average carbohydrate intake (40.2 ± 25.7%). Post-race weight was 3.6 ± 2.3% (range 0.3–5.7%) lower than pre-race weight, revealing a non-significant (p = 0.08) but practical relevant difference. In conclusion, runners were able to maintain a constant timing of food and fluid intake during competition but adjusted their food choices in the second half of the race. The large variation in fluid and carbohydrate intake indicate that recommendations need to be individualized to further optimize personal intakes.

Fluid balance in peri-operative and critical care staff

Dehydration is known to have detrimental effects on cognitive function and physical performance, as well as increasing the long-term risk of hypertension, coronary heart disease and stroke.1 A number of studies have shown inadequate nutritional and fluid intake in doctors.2,3 There is increasing evidence and interest in the importance of healthcare staff wellbeing and its implications for patient safety.4 A prospective, observational cohort study was conducted on medical and nursing staff working in peri-operative and critical care medicine at a tertiary teaching hospital over a 24 hour period. Fluid balance charts were distributed to staff who were asked to complete these for the duration of their shift. Using 2500 mls as the recommended daily fluid intake1 and average waking hours as 17,5 147 mls/hour was used as the standard with which to compare our results. Analysis was conducted using an unpaired Student t test. One-hundred-and-thirty-five fluid balance charts were distributed and 79 completed, giving a response rate of 58%. Only 3.8% of staff met the recommended fluid intake (n=3). The mean fluid intake was 76 mls/hr (± SD 32). On-call staff had a significantly lower fluid intake than those on normal shifts (24 vs. 78 mls/hr (p=0.005)). Night staff had a higher fluid intake than day staff (93 vs. 72 mls/hr (p=0.043)). Forty-seven percent of drinks consumed were caffeinated (± SD 35%). Staff passed urine 2.2 times per shift (± SD 1.0). This study found inadequate fluid intake amongst most medical and nursing staff. Study participants suggested reasons such as lack of time, limited availability of drinking facilities and staffing shortages. In spite of the small sample size, with over 96% of staff not meeting the recommended fluid intake, our results have potential implications for staff and patient safety. Dehydrated staff may be unable to perform as well cognitively and risk potentially detrimental effects on their short and long-term health. This study adds weight to existing research and highlights the need for fluid promotion among healthcare staff. 1.Benelam B, Wyness L. Nutrition Bulletin. 2010; 35: 3–25.2.Parshuram CS. Canadian Medical Assocociation Journal. 2004; 170: 965–970.3.Lemaire JB, Wallace JE, Dinsmore K, Roberts D. Nutrition Journal. 2011; 10: 18.4.Hamidi MS, Boggild MK, Cheung AM. Postgraduate Medical Journal. 2016; 92: 478–481.5.Nathaniel W, Badr MS, Belenky G, Bliwise DL, Buxton OM. Sleep. 2015; 38: 843–844.

Abstract P252: The Effects of Sodium Reduction on Metabolism and Thirst

Background: Recent studies challenge the traditional understanding of sodium physiology. Some animal studies suggest that high sodium intake may induce catabolism, leading to weight loss. Other studies suggest that high sodium intake might reduce, rather than increase, thirst. Hypothesis: Higher sodium intake increases thirst, fluid intake, and sodium excretion without altering energy intake or lowering weight. Methods: In the DASH-Sodium feeding study, adults with pre- or stage 1 hypertension without antihypertensive medications, were randomly assigned to the DASH diet or a control diet. On their assigned diet, participants consumed each of three sodium levels for 4 weeks (randomized crossover design). Participants were provided all meals, but could drink water freely. Throughout the trial, calorie intake was adjusted to keep weight constant. The three sodium levels (at 2100 kcal/d) were: low (1150 mg), medium (2300 mg), and high (3450 mg). Weight, energy intake, self-reported thirst, urine volume, plasma renin, serum aldosterone, urine osmolality, and urine sodium excretion were assessed at the end of each period. Results: Among 412 participants (57% women, 57% black, mean age 48 yrs), weight increased slightly with higher sodium on the control diet, but not the DASH diet; energy intake did not vary across sodium levels in both diets ( P -trends > 0.34) ( Table ). In contrast, participants reported more thirst with high vs low sodium (both diets P -trends < 0.001) and potentially higher fluid intake (urine volume) during the control diet (1,566 vs 1,491 ml on high vs low sodium; P -trend = 0.07). On both diets, plasma renin and serum aldosterone were lower with higher sodium (each P -trend < 0.001). Likewise, both urine osmolality and sodium excretion were higher with higher sodium intake (all P -trends < 0.001). Conclusions: Higher sodium intake did not alter energy intake, but did increase thirst and sodium excretion. These findings are consistent with the traditional understanding of the physiology of excess dietary sodium intake.

Upper metastable limit osmolality of urine as a predictor of kidney stone formation in children

High fluid intake has been universally recommended for kidney stone prophylaxis. We evaluated 24-h urine osmolality regarded as the best biomarker of optimal hydration and upper metastable limit osmolality after water evaporation from urine sample to the onset of spontaneous crystallization and its usefulness as a new risk index that would describe an individual lithogenic potential. We collected 24-h urine from 257 pediatric patients with kidney stones and 270 controls. After volume and osmolality assessment, the urine samples were subjected to volume reduction in vacuum rotavapor continued to the onset of an induced urinary crystallization. The upper metastable limit osmolality of urine sample was calculated based on its initial osmolality value and the amount of water reduction. Pediatric stone formers presented with higher urine volume and lower urine osmolality than healthy controls. Despite that, their urine samples required much lower volume reduction to induce the spontaneous crystallization than those of controls. The ROC analysis revealed an AUC for the upper metastable limit osmolality of 0.9300 (95% CI 0.9104–0.9496) for distinguishing between stone formers and healthy subjects. At the cutoff of 2696 mOsm/kg, the test provided sensitivity and specificity of 0.8638 and 0.8189, respectively. 24-h urine osmolality provided the information about current hydration status, whereas evaporation test estimated the urinary potential to crystalize dependent on urine composition. Upper metastable limit osmolality may estimate the individual lithogenic capability and identify people at risk to stone formation when exposed to dehydration.

Compliance of the recurrent renal stone former with current best practice guidelines.

Patient compliance to best practice guidelines is a significant factor in preventing renal stone recurrence. While patient compliance has been historically poor, there remains a paucity of data in the renal stone setting. We evaluated compliance of the recurrent renal stone former with current Canadian Urological Association (CUA) best practice guidelines. A prospective, cross-sectional study design was used to evaluate patient compliance. Recurrent renal stone former patients were consecutively recruited from McMaster's Institute of Urology and completed a one-time questionnaire developed in accordance with CUA best practice guidelines. Questionnaire sections included: 1) demographics; 2) interaction(s) and satisfaction with their healthcare provider; and 3) knowledge, attitudes, and compliance with best practices. A total of 300 patients were enrolled in the study; 55.3% were men, 69.5% had a history of stone surgery, while 23.7% had a positive family history. Participants perceived satisfactory education from their urologist and primary care physician 82.7% and 59.7% of the time, respectively (p<0.05). Nearly a quarter of patients (22.8%) perceived their stone disease to be severe and 67.1% of patients believed in the efficacy of preventative stone measures. Overall, 45.8% of patients were compliant with CUA best practice guidelines. The majority of patients (72.6%) complied with high fluid intake, the most critical stone preventative practice. Consistent with previous studies, compliance to dietary recommendations in this evaluation of recurrent stone formers was low. Study findings may be attributed to insufficient knowledge translation, lack of perceived disease severity, and/or patient uncertainty in the importance of preventative stone practices.

Preoperative metabolic acidosis in infants with gastroschisis.

There is little in literature regarding preoperative management of infants with gastroschisis. It is unclear if these infants develop metabolic acidosis as a consequence of prolonged intrauterine gut compromise or dehydration secondary to increased fluid loss. To assess the frequency of preoperative metabolic acidosis in infants with gastroschisis and investigate whether this acidosis reflects degree of gut compromise. All infants with gastroschisis born between May 2005 and April 2013 in a single tertiary care center were reviewed. Metabolic acidosis was defined by the presence of pH <7.26 and serum bicarbonate <18.5 or base excess < -8.5 mmol/l. Infants with significant birth depression were excluded. Maternal and neonatal data were collected. Frequency of preoperative metabolic acidosis and its association with gastroschisis prognostic score (GPS), time to first and time to reach full feeds were investigated. Sixty infants were identified, 11 were excluded (birth depression/lack of preoperative blood gases). Median preoperative total fluid intake was 130 ml/kg/d. Nine infants (18%) had metabolic acidosis at a median age of 1.2 hours. No association was found between metabolic acidosis or serum lactate and GPS, age at first feed or age at full feeds. Preoperative metabolic acidosis was identified in a significant number of patients with gastroschisis despite high fluid intake. It does not appear to be associated with the degree of gut compromise. Using metabolic acidosis as an indication of dehydration in these patients needs more investigation.

Oxalate content of beverages

A high fluid intake is an integral part of the measures for the recurrence prevention of calcium oxalate stone formation. Since dietary oxalate is a primary risk factor for hyperoxaluria, the oxalate content of a wide variety of alcoholic and non-alcoholic beverages was analyzed using a validated HPLC-enzyme-reactor method. The oxalate concentrations were 3.21–6.34mg/100mL in green and black teas, 0.28–1.96mg/100mL in iced teas and 0.08–1.82mg/100mL in herbal teas. The oxalate levels of soft, wellness, energy and sports drinks were below 0.81mg/100mL. The oxalate content varied among beer and wine, ranging from 0.30mg/100mL in white wine to 1.78mg/100mL in non-alcoholic beer. The oxalate concentration of wines was lower than that of the corresponding fruit juices. Certain beverages may provide considerable amounts of highly bioavailable soluble oxalate. Further studies should examine the effect of fermentation on the oxalate content.

Total fluid consumption and risk of bladder cancer: a meta-analysis with updated data.

With meta-analysis we tented to reveal the potential relationship between daily fluid consumption and bladder cancer risk, and to find out a recommendation on daily fluid intake. Databases of the Web of Science, PubMed and EMBASE were searched then 21 case-control and 5 cohort studies were included. Stratified analyses on gender, region, time of subjects recruiting and fluid quantity were performed as well as dose-response meta-analysis. Comparing the highest exposure category with the lowest in each study, no association appeared when all data pooled together (p=0.50), but a significant OR of 1.46 (1.02-2.08, p=0.04) was found in male subgroup. For different regions, the summarized OR was 1.44 (1.10-1.89) in American case-control studies, 1.87 (1.20-2.90) in European male subgroup and 0.24 (0.10-0.60) in Asia. There was a significant relationship that each increment 1000ml daily consumption would increase the risk by 28.6% in European male (p=0.007). Similarly every additional 1000ml consumption may increase the OR by 14.9% in American people but the association wasn't that strong (p=0.057). Stratified analyses showed fluid consumption over 3000ml/day in American residents and 2000ml/day in European male resulted in OR>1 with statistical significance. In conclusion, a relationship between higher fluid intake and higher bladder cancer risk was observed in European male and American residents and a limitation to <2000ml and <3000ml per day are recommended respectively.

Delineation of cystinuria in Saudi Arabia: A case series

BackgroundCystinuria is an inherited metabolic disease that is caused by defects in two genes, SLC3A1 and SLC7A9, which result in a renal reabsorptive defect of cystine and other dibasic amino acids, including ornithine, arginine, and lysine. Patients usually present with recurrent renal calculi and may develop renal impairment. Medical management includes high fluid intake and chelating agents. To the best of our knowledge, this is the first study describing cystinuria in Saudi Arabia.MethodsA retrospective chart review for cystinuria patients from the genetic and nephrology divisions between 2010 to 2015. All patients were investigated, diagnosed and treated at King Abdulaziz Medical City in Saudi Arabia.ResultsEight patients were identified from five unrelated families. The age of onset ranged from birth to 14 years. The female to male ratio was 1.7:1. Two new variants in the SLC3A1 and SLC9A7 genes were discovered. All of the detected mutations were missense variants in three different exons, such as c.1711 T > A (p.Cys571Ser) (exon 10), c.1166C > T p.Thr389Met (exon 11) and c.1400 T > A p.Met467Lys (exon 8). Additionally, 37.5% of our patients developed arterial hypertension and 25% had urinary tract infection, but none had renal impairment. No significant clinical differences were detected in this study between type A (SLC3A1 variants) and type B cystinuria (SLC7A9 variant). Two cases were diagnosed based on clinical information, biochemical testing and a positive family history as all of the molecular testing for cystinuria was negative.ConclusionCystinuria has wide genetic heterogeneity with a poor genotype/phenotype correlation. Negative molecular investigations should not rule out the disease if clinical and biochemical investigations support the diagnosis. A larger data registry is essential to better describe the cystinuria genotype/phenotype in Saudi Arabia.

The Role of the Tamsulosin in the Medical Expulsion Therapy for Distal Ureteral Stones.

Background:This research aims to evaluate the role of tamsulosin in the medical expulsion therapy for distal ureteral stones, including her effects in stone expulsion time, expulsion rates, stone size, pain episodes and analgesic dosage usage.Material and methods:The 104 patients with distal ureteral calculi were examined, with the size of the stones 4-10 mm. They were randomly divided into two groups: study group (n=52), received tamsulosin 0.4 mg in morning, for 28 days, analgesic (diclofenac 75 mg), high fluid intake and Control group (n=52) received analgesic (diclofenac 75 mg), high fluid intake.Results:There is no significant difference between groups, based on sex (P=0.835) and age (P=0.987). Average size of the stones was 6.5 mm (SD ± 1.6 mm), with no significant difference (P=0.996). Stone expulsion rate is 90.4% in the study group and 71.2% from the control group, with statistical significance (P=0.023). The average time of the expulsion of stones in the study group was 9.6 days (SD ± 7.1 days), control group 13.7 days (SD ± 7.3 days), with statistical significance, (P=0.034). Average dose of analgesics in the study group was 63.7 mg (SD ± 45.2 mg), control group is 109.2 (SD ± 53.3), with statistical significance (P=0.019).Conclusion:Our study reveals that tamsulosin is efficient for the treatment of distal ureteral stones. Tamsulosin decrease the number of ureteral colic episodes, by acting as a spasmolytic, increase and hasten stone expulsion rates, reduce days of stone expulsion, decrease analgesic dose usage.

Complete Metabolic Evaluation is Indicated after a First Stone Event: Con

Opposing Views Complete Metabolic Evaluation is Indicated after a First Stone Event CON A fundamental tenet in medicine is that more testing is not always better. Should we be per- forming 24-hour urine collections as part of a com- plete metabolic evaluation on every stone former? In other words, is the initial evaluation we do for first time stone formers sufficient to rule out pertinent metabolic disorders, and inform and direct dietary/ lifestyle changes to prevent recurrence? There is already a treasure trove of information gained from the initial evaluation with the first time stone former which should not be overlooked. A thorough medical history should elucidate prior urinary tract infections, any component of metabolic syndrome, gastrointestinal diseases and related surgery, relevant medications and familial stone formation. A review of the dietary and occupational history provides insight into dietary and lifestyle habits that contribute towards stone risk. Routine serum chemistry studies, including electrolytes, calcium, creatinine and uric acid, will screen for underlying metabolic disorders including renal tubular acidosis type 1, primary hyperparathyroid- ism, chronic kidney disease and hyperuricosemia. Urinalysis is helpful when high pH and low pH values are extreme, and an infection type of stone can be suspected when infection is present. Imaging will show whether multiple stones are present, overall stone burden and anatomical data. Stone analysis, when available, is sometimes helpful (uric acid, infection, brushite, genetic and drug stones) but less helpful for the majority of calcium based stones. Beyond these tests, there is the complete meta- bolic evaluation, which in current practice is the 24- hour urine collection. Several guideline panels recommend this testing in individuals at high risk for recurrence as determined by the initial eval- uation. 1e3 Interestingly, the AUA (American Uro- logical Association) also recommends metabolic evaluation in interested first time stone formers. 1 Just as not all patients at low risk for prostate cancer need definitive treatment, not all first time kidney stone formers need 24-hour urine collections leading to potential lifelong pharmacologic therapy THE JOURNAL OF UROLOGY ® O 2017 by A MERICAN U ROLOGICAL A SSOCIATION E DUCATION AND R ESEARCH , I NC . and monitoring. Stone recurrence is not guaranteed after the first event, and many first time stone for- mers remain never forma a stone again for the rest of their lives. In contemporary series symptomatic recurrence after the first episode is 30% after 10 years and 39% after 15 years. 4 In the ROKS (Recurrence Of Kidney Stone) nomogram created to predict a second symptomatic stone episode all the risk factors for the model can be extracted from the initial evaluation. 4 No tools exist to predict a second stone event incorporating 24-hour urine collection parameters. Brushing and flossing teeth are most diligently and attentively performed after a dentist visit. And so it goes with provider visits for kidney stones known as the so-called “stone clinic effect.” Multiple pharmacologic intervention trials have demon- strated significant decreases in stone recurrence in the non-intervention groups compared to pretrial rates. 5 For a subset of stone formers, maintaining high fluid intake, reducing salt intake and moder- ating animal protein intake may be enough to pre- vent the second stone event. These interventions are easily prescribed by urologists and primary care providers, achievable, low cost, safe with minimal side effects and good for general health. Perhaps a trial of nonselective dietary interventions is reasonable before proceeding with a 24-hour urine collection. Although we have relied on the 24-hour urine collection to become the “complete” metabolic evaluation there are several limitations to the test. 5 In practice the test often can be more of an art than science to interpret. Its ability to predict recurrence and prognosticate risk is not well established. Collection adequacy has been debated as to whether 1 vs 2 collections are suf- ficient or if urinary creatinine-to-body weight ratio is a reliable indicator of adequacy. Several of the positive pharmacological trials evaluating citrate did not require hypocitraturia, which is also true for several thiazide trials with hyper- calciuria. Rates of urinary metabolic abnormal- ities among first time and recurrent stone http://dx.doi.org/10.1016/j.juro.2016.12.028 Vol. 197, 1-3, March 2017 Printed in U.S.A. www.jurology.com Dochead: Opposing Views DIS 5.4.0 DTD JURO14256_14257_proof 15 December 2016 6:11 pm EO: j

Abstract 11531: The Three-Legged Stool, Balancing Diuretics, Sodium and Fluid Intake in Heart Failure

Stable sodium and fluid intake balanced with consistent oral diuretic use is thought to minimize fluid retention and avoid heart failure (HF) hospitalization. However, these 3 factors are rarely examined together so we know little about how patients manage this self-care. Purpose: To describe patterns of diuretic use with sodium and fluid intake in relation to readmission. Methods: We enrolled 24 hospitalized HF patients in a longitudinal, observational pilot study. All (16 men, 11 Blacks, mean age 60, mean HF duration 4.8 years) were discharged on a loop diuretic after hospitalization for a HF exacerbation. Over 3-months, diuretic use was measured daily using the medication event monitoring system (MEMS®). Percentage of prescribed doses taken (% PDT) was calculated and standardized (0 no adherence to 1.0 perfect adherence, &gt;1.0 extra doses) for each 2-week period. Every 2 weeks patients were called to assess diet and fluid intake. Dietary sodium was measured using a list of 24 high sodium foods (e.g., pizza, hot dogs). Validity of the measure was confirmed with formal 3-day dietary recall assessments (randomly chosen days, 2 weekdays and 1 weekend day, each month) performed on 5 participants by a registered dietitian. After in-person training on cup size, fluid intake was estimated in cups for each 2-week period. Clinical events (ED visits, hospital readmissions, death) were obtained from the electronic medical record and confirmed by self-report. Results: Six (25%) were readmitted within 3 months; 2 of the 6 died before any diuretic data could be obtained. The remaining 4 readmissions were explainable with poor diuretic use usually coupled with high sodium and/or fluid intake. In the 18 patients not readmitted, few (n=4) managed all 3 factors simultaneously, but 14 were savvy in adjusting one or two factors, showing insight that was not evident in those readmitted. Some increased their diuretic use only when sodium and fluid intake were high and decreased diuretics again later. Conclusion: Rigid guidelines regarding diuretic use, sodium and fluid intake fail to acknowledge patients’ abilities to balance these 3 factors. Promoting skill in balancing diuretic use, sodium and fluid intake may encourage expertise in self-care.

Pharmacological treatment of chronic constipation: a literature review

Chronic constipation is a very common disease that is particularly commonplace among members of the elderly population. It is one of the most widespread bowel disorders, and it causes significant pain and discomfort; as such, it usually requires medical attention. The major causes of constipation are slow colonic movements and/or functional gastrointestinal disorders. This review aimed to examine the pharmacological treatments that are currently available for chronic constipation. To develop insights into the causes and treatments of chronic constipation, relevant review articles that were published on the Pubmed, Cochrane database, and Embase websites, were examined. The outputs of these studies indicated that high daily intake of fibers and fluids in addition to regular exercise can be very helpful in avoiding and treating constipation. The pharmacological treatments that are administered to treat this disease typically increase the water content of the bowel lumen, and this leads to more regular bowel movements. Novel drugs have been introduced to treat constipation, and many of these are now subject to formal research studies. Since constipation can facilitate the development of other gastrointestinal diseases, it is important that we develop an understanding the therapeutic treatments that are available with the intention of identifying which of these may represent the most effective method for treating this disease. With that objective in mind, this review was undertaken to review the clinical effectiveness of the different pharmacological treatments that are employed to treat or prevent constipation.

Hyperoxalurie primitive : une revue de la littérature

Primary hyperoxalurias (PH) are inborn errors in the metabolism of glyoxalate and oxalate with recessive autosomal transmission. As a result, an increased endogenous production of oxalate leads to exessive urinary oxalate excretion. PH type 1, the most common form, is due to a deficiency of the peroxisomal enzyme alanine: Glyoxylate aminotransferase (AGT) in the liver. PH type 2 is due to the deficiency of the glyoxylate reductase/hydroxypyruvate réductase, present in the cytosol of hepatocytes and leucocytes. PH type 3 is linked to the gene HOGA1, encoding a mitochondrial enzyme, the 4-hydroxy-2-oxo-glutarate aldolase. Recurrent urolithiaisis and nephrocalcinosis are the markers of the disease. As a result, a progressive dysfunction of the kidneys is commonly observed. At the stage of severe chronic kidney disease, plasma oxalate increase leads to a systemic oxalosis. Diagnostic is often delayed and it based on stone analysis, cristalluria, oxaluria determination and DNA analysis. Early initiation of conservative treatment including high fluid intake and long-term co-administration of inhibitors of calcium oxalate crystallization and pyridoxine, could efficiently prevent end stage renal disease. In end stage renal failure, a combined liver–kidney transplantation corrects the enzyme defect.

Factors associated with patient recall of individualized dietary recommendations for kidney stone prevention.

Dietary approaches to preventing the recurrence of idiopathic calcium-containing kidney stones are effective. However, a lifelong commitment to prevention is challenging for many patients. Multiple patient factors likely account for compliance and adherence with dietary recommendations. We examined patients' recall and compliance with dietary recommendations provided during clinical evaluation. Of 275 patients who received dietary recommendations from a dietitian, 112 completed an investigator-designed survey querying their recollection of dietary recommendations. Patients' responses were compared with the recommendations actually provided as entered in patients' medical records. Patients (62% male, 56±13 years; 38% female, 52±14 years) were provided 3.4±1.1 recommendations (min-max, 1-6) and recalled 67% of recommendations. Highest recalls were for (i) lower meat/fish/poultry intake, (ii) higher fluid intake and (iii) lower sodium (⩾68% for all). Lowest recalls were for weight loss, using citrus juices and increasing fruits/vegetables (⩽61% for all). Forty-seven percent of patients given 1-3 recommendations recalled 100%, whereas only 23% of patients provided >3 recommendations did so (P=0.011). Even though 38% of patients reported some difficulty following dietary recommendations, nearly all (91%) said that they were willing to continue following them. Higher patient recall is associated with ⩽3 dietary recommendations. Patient recall of recommendations that were not actually provided ('false recall') may contribute to reduced recall and confusion about the most important dietary strategies to reduce their stone risk. Accordingly, providers should prioritize the most important dietary recommendations, reserving those less important for follow-up, and address any confusion patients have from information received prior to evaluation.

Recent advances in managing and understanding nephrolithiasis/nephrocalcinosis.

Urinary stone disease is a very common disease whose prevalence is still increasing. Stone formation is frequently associated with other diseases of affluence such as hypertension, osteoporosis, cardiovascular disease, metabolic syndrome, and insulin resistance. The increasing concentration of lithogenic solutes along the different segments of the nephron involves supersaturation conditions leading to the formation, growth, and aggregation of crystals. Crystalline aggregates can grow free in the tubular lumen or coated on the wall of the renal tubule. Plugs of crystalline material have been highlighted in the tubular lumen in some patients, but crystalline growth starting from plaques of calcium phosphate within the renal papillae has been demonstrated in others. Urinary supersaturation is the result of a complex interaction between predisposing genetic features and environmental factors. Dietary intake is certainly the most important environmental risk factor. In particular, an insufficient intake of dietary calcium (<600 mg/day) can increase the intestinal absorption of oxalate and the risk of calcium oxalate stone formation. Other possible risk factors that have been identified include excessive intake of salt and proteins. The potential role of dietary acid load seems to play an important role in causing a state of subclinical chronic acidosis; therefore, the intake of vegetables is encouraged in stone-forming patients. Consumption of sugar-sweetened soda and punch is associated with a higher risk of stone formation, whereas consumption of coffee, tea, beer, wine, and orange juice is associated with a lower risk. A high fluid intake is widely recognized as the cornerstone of prevention of all forms of stones. The effectiveness of protein and salt restriction has been evaluated in some studies that still do not allow definitive conclusions to be made. Calcium stone formation can be prevented by the use of different drugs with different mechanisms of action (thiazide diuretics, allopurinol, and potassium citrate), but there is no ideal drug that is both risk free and well tolerated.

International Myeloma Working Group Recommendations for the Diagnosis and Management of Myeloma-Related Renal Impairment.

The aim of the International Myeloma Working Group was to develop practical recommendations for the diagnosis and management of multiple myeloma-related renal impairment (RI). Recommendations were based on published data through December 2015, and were developed using the system developed by the Grading of Recommendation, Assessment, Development, and Evaluation Working Group. All patients with myeloma at diagnosis and at disease assessment should have serum creatinine, estimated glomerular filtration rate, and electrolytes measurements as well as free light chain, if available, and urine electrophoresis of a sample from a 24-hour urine collection (grade A). The Chronic Kidney Disease Epidemiology Collaboration, preferably, or the Modification of Diet in Renal Disease formula should be used for the evaluation of estimated glomerular filtration rate in patients with stabilized serum creatinine (grade A). International Myeloma Working Group criteria for renal reversibility should be used (grade B). For the management of RI in patients with multiple myeloma, high fluid intake is indicated along with antimyeloma therapy (grade B). The use of high-cutoff hemodialysis membranes in combination with antimyeloma therapy can be considered (grade B). Bortezomib-based regimens remain the cornerstone of the management of myeloma-related RI (grade A). High-dose dexamethasone should be administered at least for the first month of therapy (grade B). Thalidomide is effective in patients with myeloma with RI, and no dose modifications are needed (grade B). Lenalidomide is effective and safe, mainly in patients with mild to moderate RI (grade B); for patients with severe RI or on dialysis, lenalidomide should be given with close monitoring for hematologic toxicity (grade B) with dose reduction as needed. High-dose therapy with autologous stem cell transplantation (with melphalan 100 mg/m(2) to 140 mg/m(2)) is feasible in patients with RI (grade C). Carfilzomib can be safely administered to patients with creatinine clearance > 15 mL/min, whereas ixazomib in combination with lenalidomide and dexamethasone can be safely administered to patients with creatinine clearance > 30 mL/min (grade A).

Corticosterone levels and behavioral changes induced by simultaneous exposure to chronic social stress and enriched environments in NMRI male mice

Environmental enrichment (EE) is an experimental model which is believed to counteract some of the effects induced by stressors, although few studies have exposed rodents simultaneously to EE and stress. Our aim was to compare the short- and long-term effects of different housing conditions in mice submitted to chronic stress. 128 NMRI male mice arrived at our laboratory on postnatal day (PND) 21. During Phase I (PND 28), animals were randomly assigned to four experimental conditions: 1) EE+STRESS: mice housed in EE and submitted to social stress (n=32); 2) EE+NO STRESS: mice housed in EE without stress (n=32); 3) SE+STRESS: mice maintained in standard conditions (SE) and submitted to social stress (n=32); and 4) SE+NO STRESS (n=32). At the end of Phase I (PND 77), one cohort of 32 animals was used for behavioral assessment whereas another cohort of 32 was sacrificed for corticosterone analysis. Results indicated that EE animals showed less body weight, higher water and food intake, diminished anxiety response and decreased motor and exploratory behavior than SE mice. Mice exposed to stress gained less body weight, showed higher food and fluid intake and displayed decreased exploratory behavior than non-stressed mice. Furthermore, EE+STRESS group displayed significantly higher corticosterone levels than EE+NO STRESS group whereas EE+NO STRESS group showed lower levels than SE+NO STRESS. On PND 83, Phase II of the study began. Animals (n=96) were assigned to two different housing conditions: EE (n=48) and SE (n=48). On PND 112, corticosterone analysis (n=32) and behavioral study (n=64) were done. The factor “Housing Phase II” reached statistical significance. Results indicated that EE animals showed lower body weight and higher fluid intake than SE group, as well as decreased anxiety. No clear effects on motor and exploratory behavior or learning were observed. When long-term effects were analyzed, results indicated that “Initial Housing” condition was significant: animals allocated in EE during Phase I of the study showed higher corticosterone levels, lower body weight and higher fluid intake than SE mice. “Initial Stress” had significant long-term actions on food intake and exploratory behavior: animals initially reared under stress conditions displayed higher food intake and lower exploration levels on the hole-board test than non-stressed mice. In the elevated plus-maze, there were significant interactions between factors “Initial Housing” and “Initial Stress”. These factors did not reach statistical significance for motor activity or learning task. We can conclude that both short- and long-term effects of housing conditions are evident for corticosterone levels, body weight and fluid intake. Social stress induced short-term effects on body weight, food and fluid intake and exploratory behavior whereas long-acting effects were reflected on food intake and exploratory behavior. Further studies are needed in order to explore more in depth behavioral and physiological consequences of social stress and environmental enrichment.

Past, Present and Future about Ebola Virus Diseases: An Updated Review

Ebola virus is responsible for the Ebola virus diseases. The epidemic of Ebola hemorrhagic fever is a deadly disease of animal can also be transmitted to human and non-human primates. The virulence of Ebola virus involved in several immune evasion mechanisms that include an inhibition of type I interferon responsible for innate immunity, epitope masking, etc. recently Ebola virus is sexually transmitted which was reported in Liberia has associated with new clusters in regions previously declared Ebola-free. There is no appropriate antiviral vaccine or therapy is not available to work against EBOV infection in humans. However, supportive recovery practices are performed include high-fluid intake, ventilator support and broad-spectrum antibiotic therapy. The treatment and diagnosis is very important because these kind of dangerous viruses are possibly used for bio-weapons. The present review describes briefly about virology, epidemiology, pathophysiology, transmission, diagnosis and treatment of Ebola viral disease. Key words : Ebola virus, Filovirus, RT-PCR, Drug, Vaccine Development.